Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

• fast, pounding, or uneven heart rate;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

• sudden numbness or weakness, especially on one side of the body;

• sudden headache, confusion, problems with vision, speech, or balance;

• confusion, hallucinations, or seizure (convulsions);

• easy bruising or bleeding, unusual weakness;

• restless muscle movements in your eyes, tongue, jaw, or neck;

• urinating less than usual or not at all;

• extreme thirst with headache, nausea, vomiting, and weakness; or

• feeling light-headed or fainting.

Less serious side effects may be more likely to occur, such as:

• nausea, vomiting, stomach pain, loss of appetite;

• constipation or diarrhea;

• dry mouth, unpleasant taste;

• weakness, lack of coordination;

• feeling anxious, restless, dizzy, drowsy, or tired;

• sleep problems (insomnia), nightmares;

• blurred vision, headache, ringing in your ears;

• breast swelling (in men or women); or

• decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect protriptyline?

Before taking protriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Before taking protriptyline, tell your doctor if you are currently using any of the following drugs:

• cimetidine (Tagamet);

• guanethidine (Ismelin);

• tramadol (Ultram);

• heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute); or

• anti-psychotic medications such as chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), clozapine (Clozaril), olanzapine (Zyprexa, Zydis), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon), and others.

If you are using any of these drugs, you may not be able to use protriptyline, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with protriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Where can I get more information?

Your pharmacist has information about protriptyline written for health professionals that you may read.

What does my medication look like?

Protriptyline is available with a prescription under the brand name Vivactil. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication especially if it is new to you.

• Vivactil 5 mg--oval, orange, film-coated tablets

• Vivactil 10 mg--oval, yellow, film-coated tablets

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.